1. About ticagrelor
Ticagrelor is an antiplatelet medicine. It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.
Taking ticagrelor can help prevent blood clots if you have an increased risk of having them.
Your risk is higher if you have:
Ticagrelor is only available on prescription. It comes as tablets or melt in the mouth tablets.
2. Key facts
- You'll usually take ticagrelor twice a day.
- Ticagrelor is often prescribed together with low-dose aspirin.
- The most common side effects of ticagrelor are getting out of breath and bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums and bruising.
- You can drink alcohol with ticagrelor. But do not drink too much as it can irritate your stomach.
- You may need to stop taking ticagrelor for a short time before having surgery or dental treatment, but check with your doctor or dentist first.
3. Who can and cannot take ticagrelor
Ticagrelor can be taken by adults aged 18 and over.
Ticagrelor is not suitable for some people. To make sure this medicine is safe for you, tell your doctor if you:
- have ever had an allergic reaction to ticagrelor or any other medicine
- have any injuries that are currently bleeding a lot, such as a wound
- have a stomach ulcer
- have breathing difficulties, such as asthma or chronic obstructive pulmonary disease (COPD)
- have an abnormal heart rate (arrhythmia)
- have previously had a stroke caused by bleeding in the brain
- have gout or high levels of a chemical called uric acid in your body
- have liver problems
- are trying to get pregnant, already pregnant or breastfeeding
4. How and when to take ticagrelor
Always follow your doctor's instructions when taking ticagrelor.
Ticagrelor comes as 90mg tablets. It's also available as 60mg tablets for people who need a lower dose.
On your first day of treatment, your pharmacist will give you two 90mg tablets to take at the same time. After this, the usual dose is 90mg twice a day for 12 months.
If you have had a heart attack, your doctor may advise you to keep on taking ticagrelor after you've finished the 12-month course of treatment. You'll usually take a lower dose of 60mg, twice a day, for up to 3 years.
How and when to take ticagrelor
When you start taking ticagrelor, you'll take 1 dose on your first day.
After this, most people take ticagrelor twice a day, usually once in the morning and once in the evening.
You can take ticagrelor with or without food.
If you're taking melt in the mouth tablets, put the tablet on your tongue and let it dissolve. You can then swallow it with or without water.
What if I forget to take it?
If you forget to take ticagrelor, take it as soon as you remember. If it's nearly time for your next dose, skip the missed dose and take your next dose at the usual time.
Do not take a double dose to make up for a forgotten dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Taking 1 or 2 extra tablets is unlikely to harm you.
But the amount of ticagrelor that can lead to overdose is different for everyone.
Contact your doctor if you have taken some extra tablets and notice any signs of bleeding.
5. Side effects
Like all medicines, ticagrelor can cause side effects, although not everyone gets them.
Common side effects
These common side effects happen in more than 1 in 100 people.
Talk to your doctor or pharmacist if these side effects bother you or do not go away:
- bleeding more easily than normal – nosebleeds, bruising or bleeding that takes longer to stop
- unexpected shortness of breath while resting – this can sometimes happen in the first few weeks of taking ticagrelor and is usually mild
- pain and swelling in your joints – these can be signs of gout (this is because ticagrelor can lead to high levels of uric acid in your blood)
- feeling sick or indigestion
- mild rash
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Tell a doctor as soon as possible if you are coughing up blood, or there's blood in your pee, poo or vomit. This needs to be checked out as these are signs of internal bleeding.
Immediate action required: Call 999 or go to A&E now if:
- you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
Serious allergic reaction
In rare cases, ticagrelor can cause a serious allergic reaction (anaphylaxis).
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of ticagrelor. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of ticagrelor
What to do about:
- bleeding more easily than normal – be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear protective gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you're worried about any bleeding.
- shortness of breath – try breathing in slowly through your nose and out through your mouth. Sitting on a chair and leaning your chest slightly forward may also help. Your breathing will usually return to normal within a few weeks of starting ticagrelor. Tell your doctor if your symptoms do not improve or they get worse. Shortness of breath can also be a sign of an ongoing or worsening heart problem.
- pain and swelling in your joints – if you get unusual muscle pain, weakness or tiredness which is not from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.
- headaches – make sure you rest and drink plenty of fluids, but do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. If your headaches last longer than a week or are severe, talk to your doctor.
- dizziness – if ticagrelor makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drive, cycle or use any tools or machinery if you're dizzy, have muscle cramps or muscle pain, or are feeling a bit shaky.
- feeling sick or indigestion – try taking your tablets with a meal or snack, or shortly after eating. It may also help if you avoid eating rich or spicy food. If you have indigestion that does not go away, it could be a sign that you have a stomach ulcer. Talk to your doctor, as they may prescribe something to protect your stomach or switch you to a different medicine.
- diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- constipation – get more fibre into your diet, such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation.
- mild rash – it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you while you are on this medicine.
7. Pregnancy and breastfeeding
Ticagrelor and pregnancy
Ticagrelor is not recommended during pregnancy or if you're trying to get pregnant.
It's important to use contraception while you're taking ticagrelor to avoid becoming pregnant.
Talk to your doctor if you take ticagrelor and are trying to get pregnant. They may be able to recommend a more suitable medicine for you.
Ticagrelor and breastfeeding
Only take ticagrelor while breastfeeding if your doctor advises you to.
It's not known how much ticagrelor gets into breast milk, but it's likely to be a small amount, and your baby will not absorb a lot into their body from the breast milk.
If your doctor says it's OK for you to keep taking ticagrelor, then monitor your baby for any possible side effects, such as bruises or bleeding more easily than usual. However, it is unlikely that ticagrelor will cause any side effects in your baby.
Talk to your doctor, pharmacist, midwife or health visitor if you have any concerns about your baby while you're breastfeeding.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines affect the way ticagrelor works.
Tell your doctor if you're taking any of these medicines before you start taking ticagrelor:
- medicines to prevent blood clots, such as low-dose aspirin, warfarin, rivaroxaban or apixaban
- non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as citalopram
- some antibiotics like clarithromycin and rifampicin
- medicines for epilepsy, such as phenytoin and carbamazepine
- statins, such as simvastatin, used to lower cholesterol
- digoxin, for heart problems
Taking ticagrelor with everyday painkillers
Your doctor may prescribe low-dose aspirin (75mg tablets) to take together with ticagrelor.
You can take paracetamol together with ticagrelor.
Mixing ticagrelor with herbal remedies and supplements
There might be a problem with taking some herbal remedies and supplements with ticagrelor, especially ones that can affect your blood (for example, ginkgo).
St John's wort (used for depression) can reduce the levels of ticagrelor in your blood. This may stop ticagrelor from working properly and increase your chances of getting a blood clot.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about ticagrelor
How does ticagrelor work?
Ticagrelor slows the blood's clotting action by making platelets less sticky. Platelets are blood cells that stick together and block any cuts and breaks in blood vessels.
But in people at risk of heart attack or stroke, platelets can stick together inside already narrowed blood vessels to form a clot. The clot can stop blood flowing to the heart or brain and cause a heart attack or stroke.
If you take it every day, ticagrelor stops platelets from clumping together to form unwanted blood clots, and helps to prevent heart attacks and strokes.
How long does it take to work?
Ticagrelor works within 30 minutes of taking your first dose of two 90mg tablets.
You may not feel any different after you start taking ticagrelor. This does not mean that the medicine is not working.
Carry on taking it even if you feel well, as you'll still be getting the benefits.
When will I feel better?
You may not feel any different after you start taking ticagrelor. However, this does not mean the medicine is not working.
Carry on taking ticagrelor, even if you feel well, as you'll still be getting the benefits.
How long will I take it for?
You'll usually need to take ticagrelor for up to 12 months.
Your doctor may want you to continue taking it after the 12-month course has finished. If so, you'll take ticagrelor at a lower dose of 60mg a day for up to 3 years.
Is it safe to take it for a long time?
Ticagrelor is generally safe to take for a long time. In fact, it works best if you take it for many months, or even years.
If you're at risk of getting a stomach ulcer, your doctor may prescribe a medicine to help protect your stomach while you're taking ticagrelor.
What will happen if I stop taking it?
Do not stop taking ticagrelor without talking to your doctor.
If you stop taking ticagrelor, your blood will start clotting at the rate it did before you started taking it, usually within 2 days of stopping the medicine.
This means you may be at increased risk of serious problems like heart attacks or strokes.
Are there any other similar medicines to prevent blood clots?
Not all medicines that prevent blood clots are suitable for everyone.
Talk to your doctor or pharmacist to find out why you have been recommended a particular medicine.
How does ticagrelor compare with other antiplatelet medicines like clopidogrel?
Ticagrelor works just as well as clopidogrel for:
- preventing blood clots
- preventing future heart attacks if you've already had a heart attack
But ticagrelor is not approved for preventing further strokes if you've already had a stroke. In this case, your doctor may prescribe clopidogrel instead.
You'll usually take ticagrelor twice a day. Clopidogrel is taken once a day.
Clopidogrel may be less likely to cause bleeding than ticagrelor.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking ticagrelor as long as you stick to the national guidelines of no more than 14 units a week for men and women.
A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Drinking too much alcohol while you're taking ticagrelor can irritate your stomach. This can increase your risk of getting a stomach ulcer.
Is there any food or drink I need to avoid?
Do not drink grapefruit juice while taking ticagrelor. Grapefruit juice may increase the effect of your medicine, making you bleed more easily.
Can I take indigestion medicines at the same time?
Ticagrelor can be taken at the same time as indigestion medicines.
Your pharmacist will be able to recommend a suitable indigestion remedy for you.
Will I need to stop ticagrelor before having surgery or dental treatment?
Because of the risk of bleeding, you may need to stop taking ticagrelor for a short time before having surgery or dental work.
Do not stop taking ticagrelor without first talking to your doctor or dentist. They'll tell you if you need to stop taking ticagrelor before a procedure.
Can I have vaccinations?
Yes, you can have vaccinations while taking ticagrelor.
It's a good idea to mention to the doctor or nurse that you're taking an antiplatelet medicine.
Will it affect my fertility?
There's no evidence to suggest that taking ticagrelor reduces fertility in either men or women.
Will it affect my sex life?
Ticagrelor will not affect your sex life.
Will it affect my periods?
While taking ticagrelor some women may notice vaginal bleeding that's heavier than their normal period, or happens at different times.
Speak to your doctor if you're worried, or if you have postmenopausal bleeding.
Can I drive or ride a bike?
Most people can drive or cycle while taking ticagrelor.
But if ticagrelor makes you feel dizzy, do not drive a car or ride a bike until this goes away.
Can lifestyle changes help?
If you have been prescribed ticagrelor, you can also boost your health by making some key lifestyle changes.
- Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking will cut your risk of heart attack and stroke. Try to avoid secondhand smoke, too.
- Cut down on alcohol – try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
- Exercise – regular exercise keeps your heart and blood vessels in good condition. It does not need to be too energetic: walking every day is enough.
- Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products, and lean proteins. It's a good idea to follow these tips for a lower salt diet, too. Aim for no more than 6g of salt a day.
- Deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily, and your blood pressure often goes up. This raises your risk of heart attack and stroke. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
- Vaccinations – if you have heart failure, it's recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP. Ask your doctor about these vaccinations. You can have them free on the NHS.